Our society is full of discriminatory ideologies, or –isms, including racism, sexism, ageism, antisemitism, and ableism. Compared to other -isms, the media pays less attention to ableism against level one autistic people (L1A). This ableism relates to level one autistic (L1A) individuals. L1A people appear closer to “normal” (whatever normal is). Meanwhile, the autism of individuals with level 3 autism (L3A) is much more “obvious”. Individuals on that part of the spectrum may not speak often, if at all (Rudy #2, 2023). While diagnosed at a lower level, L1A individuals can still feel out of place, despite their efforts to conform. Some try to fit in by modifying their behaviors, but it is often not enough. It is very difficult for them to function in a world that was not built for them.
Social workers are trained in strengths-based approaches, and some of us have clients with disabilities. It is essential to know that autism manifests differently in each person to avoid neglecting subpopulations within the disability community. This mindset is central to providing the proper support for L1A people who appear to function at a higher degree than L3A people and others with developmental and intellectual disabilities. Disregarding their needs perpetuates ableism and neuroableism, the type of discrimination experienced by autistic and other neurodivergent people (NeuroAbleism, n.d.). It prevents this population from being full members of society.
Although many people have disabilities, ableism remains prevalent. Ableism occurs at different levels and can take many forms, such as institutional, interpersonal, and internal. An example of institutional ableism is medical ableism, which stipulates that disability is a problem that needs to be fixed. In interpersonal ableism, an individual might attempt to cure, not accept, another person’s disability. An example of internal ableism is the belief that disability accommodations are privileges (Villines, 2021). Ableism, the discrimination and/or prejudice against people with disabilities, is based on the belief that usual abilities are better, classifying people with disabilities as “less than” (Eisenmenger, 2019).
Approximately one in 54 people has autism (Johns Hopkins Bloomberg School of Public Health, 2020). Autism is misunderstood and can be an invisible disability, meaning people cannot tell whether others have this condition. To be diagnosed with autism, according to the DSM-5, an individual must have “persistent deficits in social communication and social interaction” while having “restricted, repetitive patterns of behavior” (American Psychiatric Association, 2013). Common symptoms of autism include challenges with interpreting body language, absence of facial expressions, delay of or no speech, difficulties with eye contact, abnormal tone, lack of empathy, repetitive movements (e.g., stimming), desire for routine, specific interests, and sensory sensitivities (Clinical Partners, n.d.).
A person is supposed to receive a level of autism as part of an autism diagnosis. The three levels describe the severity of symptoms. The order of levels from least severe to most severe is 1, 2, and 3 (Quaye, 2024). People with L1A often blend in with the overall population. These individuals are typically not diagnosed with autism because they do not present as the world usually views autism.
The different presentation of autism in men and women may affect the functioning of autistic people. Despite the symptoms of autism being the same in men and women, autism may present differently, leading to higher rates of misdiagnosis and/or late diagnosis for women (Engelbrecht and Silvertant, 2023). Autistic women (AW) are more likely than autistic men (AM) to mimic others, have social awareness, be more empathetic, and be “more direct [in] communication style” (Lebow, 2022). Many AW cover their autism symptoms by blending in with the traits of those around them, this action is called masking. Additionally, AWs also have a greater chance of becoming depressed (Rudy #1, 2023). AW’s strong interests are more socially acceptable than AM’s interests (Rudy #1, 2023). Due to AWs’ ability to mask their symptoms, they typically have more interpersonal relationships than AMs. (Sissons 2023). Therefore, social workers should know how autism presents in women so they can use appropriate interventions.
Despite autism’s association with deficits, Autistic people have strengths in some areas. They can also be focused, visually oriented, and creative. In addition, they can absorb and retain facts well, serve as subject experts, easily see patterns, develop innovative solutions, accept differences, and have integrity (Bennie, 2019).
L1A people presenting as allistic (non-autistic) can harm their quality of life. Through no fault of their own, they can be prevented from achieving their potential. Although they appear allistic, they can face immense communication and social challenges, especially when they are undiagnosed. Often, they are not diagnosed until much later, if at all, because society does not have a holistic understanding of how autism presents. Their autism can cause L1A people to feel like they are “different” (The Curly Hair Project, n.d.). To fit in and be accepted in a world that was built by and for allistic people, L1A people try to mask. Too much masking can cause autistic burnout, exhaustion that occurs when L1A people suppress how they naturally behave. Autistic burnout can involve stress, anxiety, depression, and suicidal ideation (Georgetown Psychology, 2022).
Although L1A people are often mainstreamed and treated as allistic, their autism, manifested sometimes in communication and/or social difficulties, can still hurt them because systems do not accommodate autistic people. They can be written off as quirky, and because they may struggle socially, they might not have an adequate support system of relatives and/or friends.
A late diagnosis can also be difficult for the families of L1A people. Relatives struggle with the diagnosis and do not want to believe that their loved one(s) has autism. As autism becomes more commonly diagnosed and since autism can cover a wide variety of people, some think that the diagnosis is not meaningful and thus fail to take it seriously. These negative feelings impede relatives from being centers of support and companionship for L1A individuals.
L1A people are considered to have “high-functioning” autism, which is an outdated term. The “high-functioning” term is harmful and dismisses this population’s challenges (Penot, 2022). As autistic author Jessica Penot (2022) wrote,
“So when we are called high-functioning, it often invalidates how disabled we feel and how much we struggle to do daily living skills, mask, and maintain. It invalidates our life experience. It reminds us that what people want is for us to continue to appear normal and to continue to mask, despite the hardship masking forces us to endure” (Penot, 2008)
Since L1A people sometimes do not present as having "classic" autistic symptoms, like stimming, they might not be diagnosed until adulthood (Leaf Complex Care, n.d.). missing critical moments for intervention. Because providers tend to diagnose and provide treatment for autism in children more than adults, a late diagnosis could prevent this population from getting any treatment.
Like others with autism, L1A people face challenges in employment (Jack, 2022). However, L1A workers are not valued because their offices often do not accommodate autism-related behaviors, such as asking clarifying questions (Heidel #1, 2022). Often, these workers are not truly given a chance to work to their full potential and are not treated respectfully. L1A employees can encounter workplace ableism when their supervisors try to enforce conformity and/or compare these individuals’ work performance to that of their colleagues without disabilities (Blanchard, n.d.). Frequently, employees with autism lose their jobs for displaying autism-related traits. These terminations can be extremely traumatic for this population (Heidel #2, 2022). It can be very difficult for autistic people to secure and maintain employment. Being unemployed for lengthy periods can make it difficult to seek employment in the future and have implications for their self-esteem.
L1A individuals often are not able to be fully included in society due to ableism. Despite them being productive employees, they are not fully accepted by society. Although they present close to being allistic, they are subjected to ableism in our allistic world, which was not built for them. It is extremely difficult, if not impossible, for this population to completely conform without suppressing their natural behaviors. Hence, their struggle with employment can lead to a decrease in quality of life.
L1A individuals must be fully and authentically included in everything. As social workers, we should use our strengths-based perspectives to accept L1A people for who they are, by not dismissing them because they may behave slightly differently than others. If we try to force them to conform, we are no better than their oppressors. We can serve as models for others and find resources that make it easier for them to access necessary treatment. As social workers, we must engage in the creation of spaces and engage in behavior that does not perpetuate ableism and set an example for others.